title: Effects of a multifaceted intervention on cardiovascular risk factors in high-risk hypertensive patients: the ESCAPE trial, a pragmatic cluster randomized trial in general practice.
abstract: BACKGROUND
  Several observational studies on hypertensive patients have shown a gap between therapeutic targets recommended in guidelines and those achieved in daily practice. The ESCAPE trial aimed to determine whether a multifaceted intervention focused on general practitioners (GPs), could increase significantly the proportion of hypertensive patients at high risk in primary prevention who achieved all their recommended therapeutic targets.
  
  
  METHODS
  A pragmatic, cluster randomized trial involving 257 GPs randomized by region. The GPs in the intervention group had a one-day training session and were given an electronic blood pressure measurement device and a short recommendation leaflet. Along with usual follow-up, they focused one consultation on hypertension and other cardiovascular risk factors every six months for two years. They also received feedback at baseline and at one year on their patients' clinical and biological parameters. Main outcome measures were change in the proportion of patients achieving all their therapeutic targets and each individual therapeutic target at two years, and quality of life.
  
  
  RESULTS
  1,832 high-risk hypertensive patients were included. After two years, the proportion of patients achieving all their therapeutic targets increased significantly in both groups, but significantly more in the intervention group: OR (odds-ratio) 1.89, (95% confidence interval (CI) 1.09 to 3.27, P = 0.02). Significantly more patients achieved their blood pressure targets in the intervention group than in the usual care group: OR 2.03 (95% CI 1.44 to 2.88, P < 0.0001). Systolic and diastolic blood pressures decreased significantly more in the intervention group than in the usual care group, by 4.8 mmHg and 1.9 mmHg, respectively (P < 0.0001 for both). There were no significant difference changes in physical and mental quality of life between groups.
  
  
  CONCLUSIONS
  An easy-to-perform, multifaceted intervention targeting only GPs increased significantly the proportion of high-risk hypertensive patients in primary prevention achieving their recommended therapeutic targets.
  
  
  BACKGROUND
  This trial was registered with ClinicalTrials.gov, number NCT00348855.
authors.affiliation: Service de Pharmacologie Clinique, Université Claude Bernard, CNRS UMR 5558, rue Guillaume Paradin, BP 8071, Lyon Cedex 08, 69376,, France. ml@upcl.univ-lyon1.fr.
authors.forename: Denis
authors.initials: D
authors.lastname: Pouchain
authors.forename: Michel
authors.initials: M
authors.lastname: Lièvre
authors.forename: Dominique
authors.initials: D
authors.lastname: Huas
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lebeau
authors.forename: Vincent
authors.initials: V
authors.lastname: Renard
authors.forename: Eric
authors.initials: E
authors.lastname: Bruckert
authors.forename: Xavier
authors.initials: X
authors.lastname: Girerd
authors.forename: Florent
authors.initials: F
authors.lastname: Boutitie
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D004032:Diet / Q000009:adverse effects; D015444:Exercise; D005602:France; D058006:General Practice; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention / Q000379:methods; D011788:Quality of Life; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents